Five things you need to know about epilepsy

Jan. 29, 2014 10:45 AM

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You probably know that epilepsy is a brain disorder that causes people to have recurring seizures. The disease has several aspects, however, with which you might not be familiar.

Epilepsy results from abnormal electrical activity in the brain. With epilepsy, abnormal electrical signals within the brain cause an “electrical storm,” which in turn causes seizures. These storms might occur in a specific part of the brain, or they may occur generally, depending on the type of epilepsy.

When a person has two or more unprovoked seizures, he or she is considered to have epilepsy. Seizures that can be linked to identifiable diseases or brain abnormalities are called symptomatic seizures. When a physician can find no cause for the seizures, they are diagnosed as cryptogenic seizures. Idiopathic, or primary, seizures are diagnosed when a genetic (or family) cause for the seizures is suspected.

Seizures are only symptoms, and people with epilepsy might experience more than one seizure type. A neurologist, therefore, must diagnose the patient’s type of epilepsy, not just the type, or types, of seizures.

You also should know these five other facts about epilepsy.

Epilepsy is relatively common.

Epilepsy is the fourth most common neurological disorder in the U.S., after migraine, stroke and Alzheimer's disease. About 2.5 million people in the United States (0.5 to one percent of the population) have epilepsy. About nine percent of Americans will have at least one seizure in their lifetimes.

Epilepsy has many forms.

The Epilepsy Foundation defines at least a dozen epilepsy syndromes, several of which affect newborns. While epilepsy causes seizures, several types of seizure-like activity are not caused by epilepsy. Migraine and transient ischemic attacks (TIA's), for example, may produce visual disturbances.

When a physician sees a patient who has had one seizure or a series of questionable events that might have been seizures, the physician must gather information to determine whether the event actually was a seizure, its type and duration, the possible cause and a prognosis.

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The physician probably would decide to treat for epilepsy if the patient has an abnormal EEG, has had a previous seizure, has another neurological impairment, or is elderly. Treatment of epilepsy usually begins with the physician prescribing regular use of a medication (there are several choices) to prevent seizures.

If medication is not effective, the physician could try other methods, including surgery, implanted devices such as vagus nerve stimulators, a special diet or complementary therapy.

Seizure symptoms vary.

While some people might experience the kind of seizure that we expect, with uncontrollable jerking movements of the arms and legs, others simply stare blankly for a few seconds during a seizure. A seizure can produce symptoms such as:

• Temporary confusion

• A staring spell

• Loss of consciousness or awareness

• Psychic symptoms

Seizures rarely are predictable.

The most common trigger is missed medication. Sleep and wake cycles and hormonal fluctuations can affect seizure frequency. Excessive use and withdrawal from alcohol or drugs may trigger seizures, as can illness or fever. Adding or removing prescription medications or supplements can trigger seizures, and, therefore, should be done gradually.

Some studies indicate that emotional stressors such as worry, anxiety and anger may cause seizures, especially if combined with fatigue or chronic sleep loss. On the other hand, with reflex epilepsy, seizures can be provoked by external stimuli, such as flashing lights, or by mental processes, such as a complex math problem.

A family history of epilepsy may be considered a clear risk factor for the disease.

People with parents or siblings who have epilepsy are at increased risk of developing seizures themselves. Some epilepsy appears to be inherited directly; the risk, however, does not follow the same principles as other inherited genetic traits.
To learn more about epilepsy, visit www.epilepsyfoundation.org.

Jeff Wagner, MD, earned his medical degree at Oregon Health Sciences University, where he also completed his residency in neurology. Dr. Wagner completed his fellowship in neurophysiology at the University of Utah. Dr. Wagner practices stroke neurology, and is the Medical Director of the Primary Stroke Center at Northern Nevada Medical Center.